In the state of New York, the No-Fault Insurance law was enacted in order to reduce the number of law suits being filed, which were arising over disputes about who was responsible for paying an injured party’s medical bills, lost wages, and claims for pain and suffering.  The No-Fault system is meant to protect an injured person from basic economic loss.  Primarily, medical bills, other necessary expenses including travel expense to and from medical facilities, prescriptions, household assistance, and wage loss.  It is not a system meant to resolve on an injured person’s claim for pain and suffering or what is otherwise referred to in the Insurance law as a “Serious Injury” claim.

When there is an automobile accident with injuries to a driver, passenger or a pedestrian, they are to be provided No-fault Insurance coverage or what is otherwise known as Personal Injury Protection.  This also pertains to those who are involved in an accident outside of the state of New York, but the vehicle they are in is insured under a New York State automobile insurance policy.  The issue of negligence or who is at fault for the causing of an accident is not relevant to the determination of which automobile insurance carrier is responsible for providing No-Fault insurance coverage.  In other words, regardless of who may have caused the accident, drivers, passengers and pedestrians are to receive insurance protection from the insurance carrier providing coverage for the vehicle they were riding in or were struck by.

Proper and Timely Notice

No-Fault Insurance is mandatory on all New York State Automobile policies.  The mandatory limit of coverage is $50,000.00.  However, in order to be eligible to receive coverage, one must complete and file a No-Fault application within thirty days of the date of the accident.  Failure to do so may bring about a denial of coverage that you would otherwise be entitled to receive.  Therefore, as the language of the automobile policy states, one must report an accident to the insurance carrier on a prompt, if not immediate, basis.  Be sure that the report includes information about any injuries to a driver, passenger or pedestrian.

Basic No-Fault Coverage

Unless you have been in an automobile accident in the past, especially one that involves injuries, it may be hard to imagine the added stress it can bring to one’s already busy life.  “I’m hurt, out of work, and I need assistance in my home and getting to my medical appointments:  Who is going to take care of the mounting medical bills related to the treatment I have received and will need in the future?  How am I to get paid wages while I am disabled and trying to get back to work?”  Let’s examine these concerns one at a time and, with this information, maybe you too will be relieved by knowing you have the answers to some of these important questions.

Medical Bills

Once you have filed your no-fault application with the proper insurance company, you have established your right to insurance protection, including payment of your medical bills.  Often, upon your arrival at a hospital or doctor’s office, you will be asked to sign a no-fault form known as an Assignment of Benefits or Authorization to Pay.  This form will allow the medical provider to submit their bills directly to the insurance company and, in turn, allow the insurance company to send their payment directly to the provider.  In most instances, this is preferable to your having to receive and submit the bills as it is one less thing that you have to do and, failure to submit your bills on a timely basis, could lead to your medical bills being denied.  However, from time to time and especially early on when coverage information may not have been shared with all of the providers, you will receive medical bills.  When you do, the bills must be submitted to the no-fault carrier within forty five (45) days from the date of service.

Other Necessary Expenses

Costs such as prescriptions, mileage to and from a medical provider and household assistance covered under a no-fault provision referred to as “other necessary expenses.”  Documentation of the expenses must be submitted to the no-fault carrier within ninety (90) days from the date that they were incurred.

To document travel expense one should create a list that includes the date of the medical visit, the name of the medical provider and the round trip mileage for the specific date of travel.

For prescriptions, submit both a copy of the prescription as well as a copy of the purchase receipt.

With regard to household assistance, a note from the attending physician will be required.  The note will need to explain that, as a result of the injuries sustained in the automobile accident, the patient is in need of household assistance.  It will need to describe how many days a week the assistance may be needed and an estimate as to how long the assistance will be required.  The doctor’s note along with documentation signed by the person providing the assistance, which describes the work that was performed, how many hours were worked and at what hourly rate the person providing the assistance was paid, should be sent to the attention of the no-fault adjuster, again, within ninety days from the date(s) of service.

It is important to keep in mind that, unless you have a policy that affords greater coverage, the monetary daily limit for “Other Necessary Expenses” is twenty five dollars ($25.00) a day and there is a one year time limit.

Wages Loss Benefits

If your injuries cause you to become disabled from work, you are entitled to receive wage loss benefits at a rate of eighty percent (80%) of your average weekly gross wage. Like other necessary expense coverage, a claim for lost earnings must be made within ninety (90) days from the first day of lost time from work.  Once lost time from work has been reported to the insurance company, they are required to send an Employer’s Wage Verification Report (NF-6) to the employer.  The completion and return of the form to the insurance company is also subject to the ninety day time requirement.  Also required is proof of your disability, which is usually in the form of a doctor’s note that verifies that you are disabled due to the injuries that you sustained as a result of the automobile accident.  Furthermore, in order to protect your claim for the continuation of wage loss benefits, a disability note should be submitted to your no-fault carrier every thirty (30) days.

Often the injured party is also eligible to receive New York State Disability as a result of becoming disabled due to a non-work related, automobile accident.  These benefits would be provided by the employer’s disability carrier and will be considered what is referred to as an off-set in regard to the no-fault wage benefits that you would otherwise be entitled to.  Therefore, you should immediately investigate whether you are eligible and, if so, file for such benefits right away.

Keep in mind that, whether you are entitled to both no-fault wage benefits and New York State Disability benefits, this does not create a windfall of income.  The no-fault carrier will simply consider what you are receiving from the disability carrier and reduce the amount they would otherwise owe so that, in the end, you are receiving the eighty percent, gross average weekly wage that you are entitled to. Payment of No-Fault wage benefits is subject to a three year time limit from the date of loss.

Greene and Reid, PLLC helps clients with making sure they are receiving the no fault coverage they are entitled to.

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If you or a loved one has been injured because of someone else’s negligence, call on the New York personal injury lawyers of Greene & Reid. Call us toll free at (800) 886-9665 or simply complete a free online consultation form, and one of our attorneys will contact you to discuss your accident and answer your questions, free of charge. Greene & Reid has successfully advocated for clients in CortlandSyracuse, and Watertown.

Our New York personal injury lawyers handle cases in the areas of auto accidentbirth injuryboating accidentbrain injuryconsumer frauddrug injuriesdog bitesinsurance disputesmotorcycle accidentnursing home abuseslip and fall accident, or wrongful death.

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